Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures -: A prospective randomized study of 100 hips
Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures -: A prospective randomized study of 100 hips
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DOI：
10.1080/000164700317362235
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发表时间：
2000-12-01
期刊：
影响因子：
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通讯作者：
Wahlström, O
中科院分区：
文献类型：
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作者：
Johansson, T;Jacobsson, SA;Wahlström, O
100例75岁或以上的股骨颈骨折患者，随机分为两个平行的经皮插入螺钉(Olmed)和全髋关节置换术(Lubinus IF)。平均年龄为84岁(75-101岁)，其中74%为女性，45%有精神障碍。关节成形术组的一般并发症较常见，但死亡率并无差异。在接骨组，有27/50髋关节出现骨折并发症。人工关节置换组主要并发症为脱位，11/50例发生脱位。在3个月和1年后，关节成形术组的Harris髋关节评分明显好于对照组。当存在精神障碍时，关节置换术后脱位率为32%，而接骨术后再手术率为5%。在精神功能正常的患者中，并发症的发生率则相反，分别为12%和60%。精神障碍患者的2年死亡率为26/45，而功能正常患者的2年死亡率为7/55(p<；0.001)。结论：对于心理功能正常、功能要求较高的老年股骨颈骨折移位患者，应考虑行全髋关节置换术。
100 patients 75 years or older, with displaced femoral neck fractures, were randomly assigned to osteosynthesis with two parallel and percutaneously inserted screws (Olmed) or total hip arthroplasty (Lubinus IF). Mean age was 84 (75-101) years, 74% were women and 45% had mental dysfunction. General complications were commoner in the arthroplasty group but the mortality rates did not differ. In the osteosynthesis group, fracture complications were seen in 27/50 hips. In the arthroplasty group, dislocation was the main complication and occurred in 11/50 cases. At 3 months and after 1 year, the Harris Hip Scores were significantly better in the arthroplasty group. When mental dysfunction was present, the dislocation rate after arthroplasty was 32%, whereas the reoperation rate after osteosynthesis was 5%. The opposite pattern of complications was found in patients with normal mental function, 12% versus 60%. The 2-year mortality rate among those with mental dysfunction was 26/45, compared to 7/55 of those with normal function (p < 0.001). We conclude that total hip arthroplasty should be considered for a displaced femoral neck fracture in old patients with normal mental function and high functional demands.